Healthcare Provider Details

I. General information

NPI: 1013668524
Provider Name (Legal Business Name): KITSAP GASTRO AND LIVER CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22180 OLYMPIC COLLEGE WAY NW STE 204
POULSBO WA
98370-6664
US

IV. Provider business mailing address

22180 OLYMPIC COLLEGE WAY NW STE 204
POULSBO WA
98370-6664
US

V. Phone/Fax

Practice location:
  • Phone: 360-447-8951
  • Fax: 360-587-2355
Mailing address:
  • Phone: 360-447-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIMBOLA ADIKE
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 360-447-8951